This post is part of our Spruce Spotlight series, where we highlight our amazing teammates at Spruce who are working on diverse projects to make healthcare communication more modern and accessible. This week, we sat down with Dr. David Craig, the Spruce medical director, to talk about his interests in medicine, technology, analytics, blogging, and his favorite Disney character.
Dr. David Craig
Years at Spruce: 5+
Role: Medical Director
Location: San Francisco, CA
How did you end up at Spruce as the medical director?
I had known for a long while that I wanted to be involved in the world of digital health because I think that good software can improve medicine. The roots of this started back when I was a teenager and really into programming and web development. I wasn’t thinking about medicine yet, but I did develop a strong belief, based on what I was creating and seeing come of age around me, that computers and responsive web technologies could help solve old and persistent problems quickly and better than ever before. What I didn’t have, though, was a problem that I wanted to solve.
In college, I then began to develop a second interest in biology and medicine. The life sciences at first seemed mostly distinct to me from what I thought I wanted out of computers and programming, but I had a moment of realization after my junior year that changed my mind. I realized, probably somewhere deep within a five-hour binge of old Scrubs episodes on DVD, that I really wanted to become a doctor and that I would always want to have that knowledge base and ability to help the people around me and to be there for them. I realized that this same medical skill set could tie back to my interest in programming and give it a motivating purpose, as it was obvious even to a college kid that medicine as a field was unforgivably far behind when it came to technology and that it could probably benefit hugely from the right software. I wanted to be a doctor, and I wanted to develop tools that could extend and magnify the capabilities of medicine.
So I went to medical school and completed my residency in emergency medicine. At the end of residency, I started looking for small startups that were working on problems that I found compelling, and that had a founding team with skills that were complementary to mine, such as engineering and company-building. I was eventually introduced to Ray Bradford (Spruce CEO), and we hit it off.
I have long believed that healthcare can and should be available to everyone and that it should be uncompromising in its quality and its accessibility. I have also long believed that thoughtful software can contribute to these necessary goals, and that Spruce and its mission aligns with all of them. And that is why I joined as medical director and why I’ve stayed.
At Spruce, you work on projects that span the fields of medicine, law, writing, analytics, and more! How has your role evolved over time?
Yeah, my role has definitely changed! When I first started at Spruce, I focused primarily on clinical operations because we were launching our direct-to-patient telemedicine clinic at the time. I was running the physician network, including its hiring and quality control, as well as developing the clinical algorithms that functioned as the base of our asynchronous approach to care.
As we figured out that the care and communication platform we had built was worth our undivided attention, we transitioned away from direct-to-patient operations, and my role evolved significantly. Since our platform began to span a number of important fields, including medicine and telecommunications, we had to develop a strong working knowledge of privacy, security, and regulatory compliance in many arenas. I ended up spending a ton of time with our lawyers and on my own, researching and writing on these topics, and in a twist I wouldn’t have predicted a few years ago, I increasingly picked up a subspecialization in legal and regulatory issues as they apply to modern healthcare and technology. Knowing what the rules are lets us be trustworthy custodians of people’s sensitive medical data, and crucially, also allows us to help guide our customers to use our platform in ways that are safe, secure, and effective for them and their patients.
Through the years, I’ve also enjoyed writing for the Spruce blog and putting together our various ebooks and webinars. Recently, I’ve also gotten to flex my old programming muscles, too, as I’ve been spending time building out our internal analytics backend and a few other internal technical tools. Those are particularly fun side projects and, I think, make up a really interesting role that I doubt most places would let their medical director get a crack at.
You still practice medicine in the emergency room weekly. How do your shifts inform your work at Spruce?
I still do a shift a week in the ER, more or less. It’s a great change of pace and it keeps me grounded in the realities of day-to-day medicine.
Above all, I love having the opportunity to do (hopefully) something useful and beneficial for the people who show up to us in need of medical care. That alone refreshes my perspective on the importance of what we’re trying to do at Spruce, how we’re trying to magnify the reach and abilities of dedicated medical teams beyond what a traditional clinic setting can let them accomplish.
My ER work also keeps me regularly exposed to the common technical tools, both software and otherwise, that practicing doctors use, and I like seeing firsthand how those tools either do or do not work well, where the major pain-points are, and what opportunities exist for improvement.
Working in the ER is also generally a good mental counterpoint to my work at Spruce. In most work environments, people work on long-term projects to build out products or systems. There may be certain days that you don’t feel as productive as others, but you move towards sustainable progress. Working in the ER, however, is like building a sandcastle. You show up and try to do some concentrated good in a short amount of time, but then, as soon as your shift is over, it sort of washes away. When I come back the next time, I have a whole new set of patients with different needs. So the two environments kind of balance each other out.
What has surprised you most about working at Spruce?
What has surprised me most has been what I’ve learned about the diversity of payment and incentive models that exist in American healthcare, some of which are materially more benign or toxic than others. It’s been critical to observe how these models are often the primary drivers of the type of care that patients end up getting and the types of tools that various care teams adopt. What makes sense in a value-based setting, for example, might seem useless or even burdensome to a traditional fee-for-service practice.
It has also been interesting to see the new and innovative medical business approaches that a number of healthcare organizations have begun to pioneer, designing systems for care that prioritize quality, access, and improved care relationships. I’m always pulling for them to succeed and to make enough money to keep the lights on. I know, though, that it can be a massive drag to fight the entrenched patterns of insurance and payers if your idea doesn’t fit into the currently dominant reimbursement model that was certainly not designed with patients’ best interests in mind.
I think this all ties into understanding why we have fundraisers for people’s chemotherapy and insulin in this country, and until those are gone, I don’t think any of our work is done, and I don’t think we’re meeting the minimum of what we owe to each other. Spruce can’t take on all of that, but I really hope we’re developing something that can be a piece of the answer.
What advice would you give to someone on their first day working at Spruce?
Complete your HIPAA training! No, seriously, I’d recommend spending some time learning about how care and money flow in the American healthcare system. Those two things, and the way they relate, define how successfully you can improve one or both of them. Generally, it’s important to really know all four of the quadruple aims: improved patient experience, better health outcomes, lowered costs, and improved clinician experience. Not just knowing what they are, but knowing how they relate within the healthcare system and where the levers of power exist to alter them. It’s impossible to change one of them in a vacuum without influencing the others.
And that’s not just important for your first day; we should all be thinking about that the whole time we’re here at Spruce. We should constantly be asking ourselves, “Why is our system like this? How can we develop a product within the current system that maximizes all aspects of the quadruple aim?” Because if we ignore the pragmatic realities of those structures, we’re going to fail.
What cartoon character would you like to have as a colleague at Spruce?
Sebastian the crab from The Little Mermaid. Even the 0.1% chance that I might one day find myself in a no-holds-barred, all-stops-pulled, all-singing-all-dancing extreme barnburning rendition of Under the Sea…that alone would make it worth it. The seaweed is always greener…
If you’re interested in joining the Spruce team and meeting our fantastic medical director, check out our job listings here.